Dive Brief:
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Though the federal government is investing in combating opioid addiction and payers and healthcare stakeholders have implemented policies to reduce overprescription, opioid addiction and overdose treatment costs in large employer-based health plans increased ninefold between 2004 and 2016, reported the Kaiser Family Foundation (KFF).
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Large employers spent $300 million on opioid addiction and overdoses in 2004. That skyrocketed to $2.6 billion in 2016. Of that amount, $1.3 billion was spent on outpatient treatment, $911 million went to inpatient care and $435 million was spent on prescription drugs. Insurance covered $2.3 billion of that total amount.
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Costs have increased despite opioid prescriptions tapering off after peaking in 2009 at 17.3% of enrollees with an opioid prescription. It fell to lower levels than a decade ago (13.6%) in 2016. Those lower rates are across all levels, but especially dropped among people with complications from pregnancy or birth, musculoskeletal conditions and injuries.
Dive Insight:
KFF used claims data from large employers to see how the opioid epidemic has affected people they cover. The researchers sampled between 1.2 million and 19.8 million enrollees per year between 2004 and 2016.
Healthcare organizations and federal and state governments are all focused on the opioid epidemic. Payers have promoted decreases in opioid prescriptions and the Trump administration has promoted funding and criminal justice measures as a way to reverse the trend. Prescription efforts appear to be working, but the KFF report shows opioid treatment costs continue to rise. KFF said one possible reason is the increase in illegal use of opioids, which employer dependents are taking.
This report shows that despite improvements, a multifaceted approach is needed to reverse the opioid epidemic.
It found that opioid addiction and overdose treatment accounted for about 1% of total inpatient spending by people with large employer coverage and 0.5% of total outpatient spending in 2016. That’s an increase from 0.3% of total inpatient spending and 0.1% of total outpatient spending in 2004.
Inpatient and outpatient treatment for opioid addiction and overdose added $26 per person to the annual cost of health benefits coverage for large employers in 2016. That’s up from only $3 in 2004.
Though treatment and overdose costs increased, spending on opioid prescription painkillers dropped as doctors wrote fewer prescriptions. Large employer plans and enrollees spent $1.4 billion in 2016, which is a decrease from $1.9 billion in 2019. Members spent $263 million (19%) out-of-pocket for opioid prescriptions in 2016.
The report found that older adults received most of the opioid prescriptions, as 22% of people in the 55-64 range had at least one opioid prescription in 2016. The second highest age range was 45-54, which had a 19% opioid prescription rate.
That’s compared to 12% of young adults and 4% of children. However, most of the $2.6 billion spent on opioid addiction and overdose treatment was spent on treating young adults.